Male Pattern Hair Loss

Are you or someone you know suffering from male pattern baldness? You may be eligible to participate in an upcoming clinical research trial!

Upcoming Studies

About the Study

This upcoming clinical trial is exploring new investigational treatment options for male pattern hair loss, and participants may receive therapies to help combat thinning hair. Stay tuned for more information about qualifications, treatment details, and how you can take part. To see if you qualify, please submit the contact form below or give us a call for further details.

Condition Male pattern baldness

Status Upcoming

What are the benefits of enrolling?

Study medication at no cost, no insurance needed
The opportunity to contribute to medical research
Study visits conducted by a trained and dedicated research team
Evaluations performed by one of our board-certified dermatologists

If you would like additional information about this study, or to schedule an appointment to see if you qualify, please call our office at 586-286-7325. You may also fill out the Clinical Trial Request form below, and we’ll make sure to reach out to you as soon as possible.

First Name*

M.I.

Last Name*

Date of Birth

Email*

Phone*

City

State

How did you find us?

Clinical Trial of Interest* (Select all that apply):

Male Pattern Hair Loss

Questions/Comments

NOTICE: HIPAA AUTHORIZATION REQUIRED TO USE THIS FORM. SIGNATURE FIELD BELOW.

HIPAA AUTHORIZATION. To the extent information in this form is protected health information under the Health Insurance Portability and Accountability Act, as amended, and its regulations (“HIPAA”), I authorize the use and disclosure of such information in accordance with this HIPAA AUTHORIZATION. I authorize the use and disclosure of all of the information that I have entered into this form (“Information”). I am the individual whose Information is included in this form or I am the personal representative of that individual. The purpose of this disclosure is to allow communication of the Information to a the medical practice from whose website I obtained this form. The Information will be disclosed to Dermatologists Of Central States and/or its information technology contractors (“Recipients”) in order to facilitate communication between me and the medical practice. I understand that I have the right to revoke this Authorization at any time prior to my submission of this form by simply not signing this Authorization, but once I sign this Authorization and submit the form, the Information will be disclosed to Recipients in reliance upon my Authorization. I understand that I am not required to sign this Authorization and that any medical practice making this form available on its website may not condition my treatment on whether I use this form to communicate with the medical practice. This Authorization has no expiration date. I understand that the Information used or disclosed pursuant to this Authorization may be subject to re-disclosure by the Recipients and will no longer be protected by HIPAA. I hereby acknowledge that I may print a copy of this Authorization for my records.
TYPE YOUR FULL NAME BELOW AS SIGNATURE AND AUTHORIZATION*

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